Intraepithelial lesion spreading around the main lesion of esophageal carcinoma may be significant for the evaluation of the prognosis. Therefore, we classify it into 5 types from X-ray findings and compare these types with the findings of the resected specimens.
i) A-type is characterized by slight rigidity seen at the margin of the esophagus and coarseness of the mucosal pattern.
ii) In B-type, together with rigidity of the esophageal wall, a fine granular pattern is seen on double contrast film.
iii) C-type, in which nodular and granular features of various sizes are seen, is divided into 2 sub-types, i. e., C
1 and C
2. Small nodular features belong to C
1 and large nodular ones with deep ulcer to C
2.
iv) Big nodules with smooth surface and scattered lesions with fine elevations characterize D-type.
Histological examination of the superficially spread lesion of A-type reveals carcinoma in situ. Likewise, carcinoma in situ with erosion is found in many cases of B-type. In C
1- and C
2-types, carcinoma infiltrates to or beyond the submucosal layer to form nodules. In most cases of D-type, lymphatic vessel invasion is seen in the mucosal layer and metastatic lesion comes out to the surface of the mucosa.
The prognosis of early esophageal carcinoma of A-type is good, but that of B-, C- and D-types is rather poor.
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